In this E-Learning module, the author provides epidemiology and prognosis of cancer during pregnancy. He draws attention to the problem of frequently delayed diagnosis and potential sub-optimal treatment of cancer during pregnancy. He also provides general considerations in terms of treatment of cancer during pregnancy, as well as in terms of foetal and obstetrical care.
The author elaborates the reasons of a delayed diagnosis of cancer during pregnancy, such as misinterpretation of symptoms, physician and patient denial of cancer occuring in that age range. He provides some diagnostic considerations and underlines that, for a proper clinical management, the trimester of pregnancy at cancer diagnosis is a crucial factor.
The module puts emphasis on the adherence to the clinical practice guidelines available on this topic, which is mandatory.
In terms of surgery, the author underlines a slightly higher risk of miscarriage in the first trimester, increased morbidity and pregnancy complications in case of major abdominal and pelvic surgical procedures, and provides considerations in terms of careful monitoring of maternal and foetal conditions.
In terms of radiotherapy during pregnancy, the module addresses the increased risk of foetal malformation, mental retardation associated with certain radiation dose exposure and when the radiation dose, with adequate shielding, does not reach sites away from the uterus. Uncertainty regarding risk of cancer and sterility exists even with low doses.
Most chemotherapy agents can be safely administered during the second and third trimesters of pregnancy. The use of targeted agents, endocrine therapy and immunotherapy should be postponed after delivery.
The author underlines that the goal of anticancer treatment during pregnancy is to achieve full-term delivery. Pregnancies where the foetus has been exposed to chemotherapy starting in the second trimester should be considered high risk and regular foetal monitoring during gestation should be considered. Close monitoring of these pregnancies is recommended considering the increased risk of foetal and obstetrical complications.
The author illustrates general considerations with examples and specificities in several types of cancer when occurred during pregnancy.
